Provider Demographics
NPI:1891008330
Name:UNIVERSITY OF SOUTH ALABAMA HEALTH SERVICES FOUNDATION
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH ALABAMA HEALTH SERVICES FOUNDATION
Other - Org Name:USA ORTHOPAEDIC REHABILITATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-470-5842
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:3421 MEDICAL PARK DR
Practice Address - Street 2:2 MEDICAL PARK, RM 160
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3330
Practice Address - Country:US
Practice Address - Phone:251-665-8201
Practice Address - Fax:251-665-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies